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Case Reports
. 2015 Jan-Mar;5(1):41-4.
doi: 10.13107/jocr.2250-0685.252.

Osteofibrous Dysplasia managed with Extraperiosteal excision, Autologous free fibular graft and bone graft substitute

Vineet T Abraham  1 , Chandrasekaran Marimuthu  1 , Ravichandran Subbaraj  1 , Nandakumar Rengarajan  1
Affiliations
Case Reports

Osteofibrous Dysplasia managed with Extraperiosteal excision, Autologous free fibular graft and bone graft substitute

Vineet T Abraham et al. J Orthop Case Rep. 2015 Jan-Mar.

Abstract

Introduction: Osteofibrous Dysplasia is a rare benign self-limiting fibro-osseous lesion most commonly seen in the diaphysis of the tibia. Its incidence is reported to be 0.2% of all primary bone tumors. It occurs in the first two decades of life with a slight male preponderance. Surgical options include extra periosteal resection, autologous graft, limb lengthening procedures etc. There are no case reports mentioning the use of synthetic bone graft to fill the defect following extraperiosteal excision.

Case report: A 13 year old girl presented with pain and swelling of the (R) leg since 2 months following a trivial injury at school. Examination revealed a 5×3cm tender swelling on the anteromedial aspect of the middle third tibia. Radiographs and MRI, revealed an eccentric expansile lytic lesion, which was multilocular and was present at the junction of the metaphysis and diaphysis on the antero -medial aspect of tibia. The cortex had ballooned out and there was a possibility of an impending fracture. Biopsy was done which revealed osteofibrous dysplasia. We did an extraperiosteal excision of the lesion. To fill the cavity we harvested 10 cm of the contralateral fibula and since there was still space in the cavity, we packed bone graft substitute (hydroxyapatite crystals) into the defect. The surgical management of osteofibrous dysplasia is controversial. Various methods of treatment of such cases have been described in literature. The use of synthetic graft is an option in these patients as it reduces morbidity; and in our case we had good graft incorporation with this method.

Conclusion: Extraperiosteal Excision of Osteofibrous dysplasia combined with autologous free fibular graft and bone graft substitute is a good surgical option to prevent recurrence and mange bone defects in this rare lesion.

Keywords: Autologous free fibular graft; Bone graft substitute; Osteofibrous Dysplasia.

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Conflict of interest statement

Conflict of Interest: Nil

Figures

Figure 1
Figure 1
Radiographs of tibia revealed an eccentric expansile lytic lesion, which was multilocular and was present at the junction of the metaphysis and diaphysis on the antero -medial aspect of tibia
Figure 2
Figure 2
Surgical Procedure: a- exposure of the lesion and b- extraperiosteal excision. c- autogenous non vascularised fibula graft in situ and d- immediate post operative radiographic appearance.
Figure 3
Figure 3
Two year follow tip radiographs showed good healing and no recurrence
See this image and copyright information in PMC

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